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Research ArticleOriginal Research

Obstetric Care by Family Physicians and Infant Mortality in Rural Alabama

Jessica Powell, Catherine Skinner, Drake Lavender, Daniel Avery and James Leeper
The Journal of the American Board of Family Medicine July 2018, 31 (4) 542-549; DOI: https://doi.org/10.3122/jabfm.2018.04.170376
Jessica Powell
From the Departments of Family, Internal, and Rural Medicine (JP, CS, DL) and Community Medicine and Population Health (DA, JL), University of Alabama College of Community Health Sciences, Tuscaloosa, AL.
MS, MD
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Catherine Skinner
From the Departments of Family, Internal, and Rural Medicine (JP, CS, DL) and Community Medicine and Population Health (DA, JL), University of Alabama College of Community Health Sciences, Tuscaloosa, AL.
MD
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Drake Lavender
From the Departments of Family, Internal, and Rural Medicine (JP, CS, DL) and Community Medicine and Population Health (DA, JL), University of Alabama College of Community Health Sciences, Tuscaloosa, AL.
MD
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Daniel Avery
From the Departments of Family, Internal, and Rural Medicine (JP, CS, DL) and Community Medicine and Population Health (DA, JL), University of Alabama College of Community Health Sciences, Tuscaloosa, AL.
MD
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James Leeper
From the Departments of Family, Internal, and Rural Medicine (JP, CS, DL) and Community Medicine and Population Health (DA, JL), University of Alabama College of Community Health Sciences, Tuscaloosa, AL.
PhD
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Article Figures & Data

Figures

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  • Figure 1.
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    Figure 1.

    Map of Alabama Counties.

  • Figure 2.
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    Figure 2.

    Cumulative infant mortality rate (IMR) data (infant death per 1000 live births).

Tables

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    Table 1.

    State and Selected County Demographics6,7

    County2000 US Census
    Population (n)Nonwhite Race (%)Eligible for Medicaid (%)
    Pickens (intermittent service)20,94944.023.6
    Clarke (continuous service)27,86744.125.5
    Monroe24,32442.220.1
    Coosa (no service)12,20236.115.9
    Conecuh14,08944.628.1
    Alabama4,447,10024.215.2
    • View popup
    Table 2.

    Periods 1, 2, and 3 as Determined by Obstetrics Services Availability in Pickens County

    PeriodYearsService Availability
    11986–1991No local obstetrical services
    21993–2001Local prenatal care + local deliveries
    32005–2013Local prenatal care
    • View popup
    Table 3.

    Cumulative Infant Mortality Rate of Selected Counties During Periods 1, 2, and 3

    Cumulative IMR
    Period 1 (1986–1991)Period 2 (1993–2001)Period 3 (2005–2013)P value (time)
    United States*9.77.46.4
    Alabama*12.09.98.9
    Pickens County17.9a7.2b16.0a.003
    Clarke + Monroe Counties14.5a8.3b9.9b.004
    Coosa + Conecuh Counties12.5a14.4a10.9a.52
    P value (county).34.006.09
    • Data are infant deaths per 1000 live births, unless otherwise indicated. Values with different superscript lowercase letters within each row differ significantly (P < .05).

    • ↵* Mean rates.

    • IMP, infant mortality rate.

    • View popup
    Table 4.

    Cumulative Rate of Low Birth Weight in Selected Counties During Periods 1, 2, and 3

    Cumulative Rate of LBWP value (time)
    Period 1 (1986–1991)Period 2 (1993–2001)Period 3 (2005–2013)
    Alabama*8.29.310.5
    Pickens County9.9a11.5a11.8a.09
    Clarke + Monroe Counties9.0a9.8a13.8b<.001
    Coosa + Conecuh Counties9.5a12.4b12.5b.001
    P value (county).49<.001.053
    • Low birth weight (LBW) values with different superscript lowercase letters within each row differ significantly (P < .05).

    • ↵* Mean rates.

    • View popup
    Table 5.

    Cumulative Births to Females Aged 10 to 19 Years in Selected Counties for Periods 1, 2, and 3

    Cumulative Births (%)
    Period 1 (1986–1991)Period 2 (1993–2001)Period 3 (2005–2013)P value (time)
    Alabama*18.217.613.4
    Pickens County20.3a22.2a12.4b<.001
    Clarke + Monroe Counties22.0a20.7a15.5b<.001
    Coosa + Conecuh Counties24.2a19.2b15.7c<.001
    P value (county).01<.001.002
    • Data are percentages unless otherwise indicated. Values with different superscript lowercase letters within each row differ significantly (P < .05).

    • ↵* Data are from 1990 (period 1), 1997 (period 2), and 2009 (period 3).

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The Journal of the American Board of Family     Medicine: 31 (4)
The Journal of the American Board of Family Medicine
Vol. 31, Issue 4
July-August 2018
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Obstetric Care by Family Physicians and Infant Mortality in Rural Alabama
Jessica Powell, Catherine Skinner, Drake Lavender, Daniel Avery, James Leeper
The Journal of the American Board of Family Medicine Jul 2018, 31 (4) 542-549; DOI: 10.3122/jabfm.2018.04.170376

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Obstetric Care by Family Physicians and Infant Mortality in Rural Alabama
Jessica Powell, Catherine Skinner, Drake Lavender, Daniel Avery, James Leeper
The Journal of the American Board of Family Medicine Jul 2018, 31 (4) 542-549; DOI: 10.3122/jabfm.2018.04.170376
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Keywords

  • Alabama
  • Family Physicians
  • Infant Mortality
  • Population Health
  • Prenatal Care
  • Rural Population

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